Chou Benjamin, Bohn Jacqueline Ann, Mairs Robert
Pacific Northwest University of Health Sciences, Yakima, Washington, USA.
University of Utah, Salt Lake City, Utah, USA.
J Med Case Rep. 2016 Dec 20;10(1):369. doi: 10.1186/s13256-016-1154-6.
Hematometra is a pathologic collection of blood in the uterus. It is a rare condition that is most commonly associated with congenital anomalies or prior surgical procedures causing an obstruction of the genitourinary outflow tract. We present an unusual case of hematometra in a healthy and active adolescent female with no prior risk factors. This is a rare and important case report due to the complexity of diagnosis when a young female presents with an acute abdomen. In addition, for a patient who presents with no prior risk factors for hematometra, such as in our patient, the diagnosis and workup may become overly complicated, adding strain to patient care and health care cost. To the best of our knowledge and based on an extensive literature search, there has not been a reported case of hematometra in an adolescent female without any aforementioned risk factors.
Our patient is a healthy 18 year-old white woman with no significant prior medical or surgical history. Her only medication was depot medroxyprogesterone acetate use for contraception. She presented to a local emergency department with acute abdominal pain, accompanied by emesis and nausea. Workup with ultrasonography showed uterine distention most likely caused by hematometra, although no obvious cause was noted. She was treated with dilation and curettage; she was also advised to discontinue depot medroxyprogesterone acetate use. She was symptom free without recurrence of hematometra at 6-month follow-up.
Due to the high prevalence of abdominal pain, this case report has a wide breadth of implications for health care providers ranging from general family practitioners to emergency room physicians and obstetricians/gynecologists. This case report provides potential future advancement in management and differential diagnosis in adolescent females presenting with acute abdominal pain. In addition, the use of depot medroxyprogesterone acetate contributing to or causing hematometra cannot be ruled out in our patient and warrants further investigation.
子宫积血是子宫内病理性血液积聚。这是一种罕见病症，最常与先天性异常或先前导致泌尿生殖系统流出道梗阻的外科手术相关。我们报告一例健康且活跃的青春期女性发生子宫积血的不寻常病例，该女性无既往危险因素。鉴于年轻女性出现急腹症时诊断的复杂性，这是一例罕见且重要的病例报告。此外，对于像我们的患者这样无子宫积血既往危险因素的患者，诊断和检查可能会变得过于复杂，增加患者护理负担和医疗成本。据我们所知并经广泛文献检索，尚无无任何上述危险因素的青春期女性发生子宫积血的报道病例。
我们的患者是一名健康的18岁白人女性，既往无重大医疗或手术史。她仅使用醋酸甲羟孕酮长效避孕针进行避孕。她因急性腹痛就诊于当地急诊科，伴有呕吐和恶心。超声检查显示子宫扩张，很可能由子宫积血引起，尽管未发现明显病因。她接受了刮宫治疗；还被建议停用醋酸甲羟孕酮长效避孕针。6个月随访时她无症状，子宫积血未复发。
由于腹痛的高发性，本病例报告对从普通家庭医生到急诊医生以及妇产科医生等医疗服务提供者具有广泛影响。本病例报告为青春期女性出现急性腹痛的管理和鉴别诊断提供了未来潜在的进展。此外，在我们的患者中不能排除醋酸甲羟孕酮长效避孕针促成或导致子宫积血的可能性，值得进一步研究。
